Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: a possible manifestation of methotrexate hypersensitivity.
Large haemorrhagic and necrotic cutaneous lesions developed after two low dose (5 mg) methotrexate injections in a patient suffering from long standing rheumatoid arthritis. Differential clinical diagnosis included factitia dermatitis, infectious processes, pyoderma gangrenosum, rheumatoid neutrophilic dermatitis, necrotizing arteritis and vasculitis. Histological and direct immunofluorescent examinations of skin biopsies supported the diagnosis of leucocytoclastic vasculitis. We discuss the respective roles of methotrexate and rheumatoid arthritis in the outbreak of leucocytoclastic vasculitis. Hypersensitivity is strongly suspected.
Simonart
T
T
Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Durez
P
P
Margaux
J
J
Van Geertruyden
J
J
Goldschmidt
D
D
Parent
D
D
D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000473:pathology
D018501:Antirheumatic Agents; D008727:Methotrexate